“Turn on, Tune in, Drop out “Substance Abuse in the Workplaces of our bodies and mind..

Warren Silverman MD

Brief History of Drug abuse – Mary Jane

1629 – Marijuana introduced to the Puritan colonies of

New England

1765 – George Washington was cultivating Marijuana for a

sore tooth

1800’s Tincture of Cannabis is available from pharmacies,

unpopular due to variations in potency and dosage, but

recreational use continues with Hashish clubs in most cities

by 1885

By the 20th century, marijuana use was associated with

racial groups and drug abusers and lost popularity

The foreign origin of marijuana lead to propaganda

against its use (as we have just seen), by 1930’s marijuana

was considered wicked

In the 1960’s, drug use was considered a demonstration of

anti-establishment leanings and became popular

Marijuana has remained a constant presence in our society

with gradual legislation to decriminalize and legitimize its

use

Brief History of Drug Abuse - Opiates

In colonial America, Opiate medications were common in London and

imported to the colonies – used to treat pain from diarrhea, colds,

fever, tooth aches, cholera, rheumatism, pelvic disorders, athlete’s

foot and baldness

1784 Dr. William Buchan’s book tells people how to make their own

tincture of Opium (paregoric) to keep around the house

1804 catalogue listed 90 brands of elixir, by 1905 it was more than

28,000

1803 Morphine developed (Morpheus – god of dreams) Hypodermic

needle invented and by the civil war Morphine was widely used as

injectable

1898 Heroin developed by Friedrich Bayer : initially used

for cough and lung conditions (tuberculosis, pneumonia),

later used to treat Morphine addiction

1900 State of Vermont sold 3.3 million doses of opium a

month

Considered a Ghetto drug, Heroin use increased

dramatically in the 60’s

After the 60’s, the medical community was scared to use

opiates for fear of creating addicts

In the early 80’s literature came out scolding doctors for

failing to adequately treat the pain of TERMINALLY ILL

patients, as a result there was a marking increase in

opiates in this population

In the beginning of this century, drug manufacturers had

found a lucrative market in long acting preparations of

opiates and aggressively marketed the use of these agents

in patients with non terminal illnesses

Anesthesiologists and Primary care physicians recognized a

lucrative opportunity in pain management, initially to

supplement their income, later to specialize in it

Opiate use sky rocketed with patients being treated with

high dose opiates for conditions as benign as osteoarthritis

A rapid rise in community diversion, abuse and opiate

overdose has created a spotlight on this practice and

legislation to combat this type of use. The pendulum is

swinging away from opiate use in non-acute situations

U.S. Leads the World

in Illegal Drug UseDespite the fact that American people make up only

four percent of the global population, they still manage to use two-thirds of illegal drugs worldwide

How many drug addicts are there in the United States?

According to the National Survey on Drug Use and Health (NSDUH), an estimated 20 million Americans aged 12 or older used an illegal drug in the past 30

days. This estimate represents 8% percent of the population aged 12 years old or older.

Young People Use

In 2014, 467,000 adolescents were current nonmedical users of pain reliever,

with 168,000 having an addiction to prescription pain relievers.

In 2014, an estimated 28,000 adolescents had used heroin in the past year,

and an estimated 16,000 were current heroin users. Additionally, an

estimated 18,000 adolescents had heroin a heroin use disorder in 2014.

People often share their unused pain relievers, unaware of the dangers of

nonmedical opioid use. Most adolescents who misuse prescription pain

relievers are given them for free by a friend or relative.

The prescribing rates for prescription opioids among adolescents and young

adults nearly doubled from 1994 to 2007.

Drug overdose is the leading cause of accidental death in the US, with 47,055

lethal drug overdoses in 2014.

Opioid addiction is driving this epidemic, with 18,893 overdose deaths related to

prescription pain relievers, and 10,574 overdose deaths related to heroin in 2014.

From 1999 to 2008, overdose death rates, sales and substance use disorder

treatment admissions related to prescription pain relievers increased in

parallel.

The overdose death rate in 2008 was nearly four times the 1999 rate; sales of

prescription pain relievers in 2010 were four times those in 1999; and the

substance use disorder treatment admission rate in 2009 was six times the 1999

rate.

In 2012, 259 million prescriptions were written for opioids, which is more

than enough to give every American adult their own bottle of

pills.

Four in five new heroin users started out misusing

prescription painkillers.

As a consequence, the rate of heroin overdose deaths nearly

quadrupled from 2000 to 2013.

During this 14-year period, the rate of heroin overdose

showed an average increase of 6% per year from 2000 to

2010, followed by a larger average increase of 37% per year

from 2010 to 2013.

94% of respondents in a 2014 survey of people in treatment

for opioid addiction said they chose to use heroin because

prescription opioids were “far more expensive and harder

to obtain.

Types of Drug Testing – 6 Basic Types

Occupational

Pre-employment

Random

For Cause – Suspicion

Post Accident

Return to Duty

Follow – up

Federally Mandated programs

Federal motor Carrier Safety

Administration (CDL)

Federal Aviation Administration

Federal Railroad Administration

Unites States Coast Guard

Pipeline and hazardous Material

Safety Administration

Federal Transit Administration

Department of Energy

Nuclear Regulatory Commission

Department of Defense

Drug-free Workplace Act of 1988

Any organization that receives a

federal contract of $100,000 or

more

Any organizations receiving a

federal grant of any size

Pre-employment

Pre-employment drug testing is the most common "type" of workplace drug

testing employed in the general workforce.

Legally, pre-employment testing can be required of a job candidate only after

a formal "Conditional Offer of Employment" has been made.

Companies with USDOT-regulated employees (transportation, oil-gas, etc.)

are required under 49 CFR Part 40 et al to do pre-employment testing.

Non-regulated companies are not required to do pre-employment tests. But

each year, a growing percentage of non-regulated companies do so.

Pre-employment testing is a good policy, since it is a first-step in establishing

and maintaining a Drug-Free Workplace.

Random Drug Testing

This testing is not for the purpose of catching substance abusers,

although it frequently does

The purpose is to act as a deterrent

All employees being monitored work with the understanding that they

may be asked on short notice to undergo a drug test at any time

Employees are chosen randomly and only a percent of the employee

pool is tested each year.

After testing, names are thrown back in the pool and may be chosen

multiple times in a year while others are not tested

Employees must show up within prescribed period of time after being

notified – “Proceed Immediately”

Limit knowledge of the selection list

Failure to test is equal to a positive

For Cause – Reasonable Suspicion Testing is performed when there is a reasonable suspicion that the employee

is performing their duties while under the influence of a prohibited substance

Initiation of a Reasonable Suspicion program requires:

Individuals at the employer who have received training on recognizing the signs of

substance use

Documentation specifically of aberrant behaviours

Immediate supervised transportation to and from the testing site

The USDOT requires "Reasonable Suspicion" training for supervisors of

companies with DOT-regulated employees.

Non DOT does not require training, but it is important to do so to avoid

litigation and improper selection for testing

For Cause testing runs the highest positive rates

Rapid testing is frequently used, follow up laboratory testing is important to

offer accuracy and legal back-up

Post Accident - DOT

Who was performing safety-sensitive functions with respect to the vehicle, if

the accident involved the loss of human life; or

Who receives a citation within 8 hours of the occurrence under State or local

law for a moving traffic violation arising from the accident, if the accident

involved:

Bodily injury to any person who, as a result of the injury, immediately

receives medical treatment away from the scene of the accident;

One or more motor vehicles incurring disabling damage as a result of the

accident, requiring the motor vehicle to be transported away from the scene

by a tow truck or other motor vehicle.

Up to 32 hours following the accident for drugs

Alcohol within 2 hours or if longer, documentation of the reason why with

testing attempts to stop after 8 hours

Post Accident – Non DOT

For situations including but not limited to

Injury to an employee or others requiring medical assessment

Damage to company property

Occurs while at work or on company property

Testing of the injured employee AND the employee who caused the accident

or injury

Testing to occur as soon as possible, but up to 32 hours post accident

Alcohol within 2 hours or documented reason up to 8 hours

Jurisdictions that limit post accident testing

Return to Duty-

for previously suspended employees

Passing a drug test as a condition of a "Return to Duty" is required of DOT-

regulated employees.

"IF" their company's written Drug-Free Workplace Policy allows for re-hire

after a policy rule violation.

Return to Duty testing also requires a prior completion of a successful

counseling by a Substance Abuse Professional (SAP) before re-hire.

(DOT-regulated company policies are NOT required to allow for re-hire after a drug policy rule violation. But

they must stipulate that in their written policy if that is the case.)

Non federal programs often mirror federal policy, but some have a zero –

tolerance policy while others are much more liberal

The Use of an SAP or an EAP

Follow-up examinations

Observed Sample

In DOT a minimum of 5 random tests over the next 12 months with more

allowed

Done in addition to other testing (IE: Random, for cause, post accident)

Usually managed by the SAP in federal testing

Requires a negative drug screen before this program can start

Urine collection

PRO

Highest assurance of reliable

results

• Least expensive

• Most flexibility in testing

different drugs, including alcohol

and nicotine

• Most likely of all drug testing

methods to withstand legal

challenge

con

Specimen can be adulterated,

substituted, or diluted

• Limited window of detection

• Test sometimes viewed as

invasive or embarrassing

• Biological hazard for specimen

handling and shipping to lab

Window of Detection : Typically 1 to 5 days

Longer for marijuana

Traditional testing used since 1983. GC/MS confirmation is considered gold

standard of drug testing. Acceptable for all testing categories. Both lab and

instant testing available.

HAIR COLLECTION

PRO CON

More expensive

Test usually limited to basic 5- drug

panel

Cannot detect alcohol use •

Will not detect very recent drug

use (1 to 7 days prior to test)

Longer window of detection

Greater stability (does not deteriorate)

Can measure chronic drug use

Convenient shipping and storage (no need to refrigerate)

Collection procedure not considered invasive or embarrassing

More difficult to adulterate than urine • Detects alcohol/cocaine combination use

Window of Detection: Depends on

the length of hair in the sample

Hair grows about a half-inch per

month, so a 1-1/2 inch specimen

would show a 3-month history.

New federal guidelines propose

that head hair should be the only

type of hair to be used for pre-

employment, random, return-to-

duty, and follow-up testing.

Because of detection times not to

be used for post-accident and

reasonable suspicion testing.

ORAL FLUIDS - SALIVA

PRO

• Sample obtained under direct

observation

Minimal risk of tampering

Non-invasive

Samples can be collected easily in

virtually any environment

Can detect alcohol use

Reflects recent drug use

CON

Drugs and drug metabolites do not

remain in oral fluids as long as they

do in urine

Less efficient than other testing

methods in detecting marijuana

use

Window of Detection

Approximately 10 to 24

hours

Typical uses

Used primarily for post-accident

and reasonable suspicion testing.

Some companies are using for pre-

employment.

Not to be used for return-to-duty

and follow-up testing.

Both lab and instant testing

available.

SWEAT PATCH

PRO

Non-invasive

Variable removal date (generally 1

to 7 days)

Quick application and removal

Longer window of detection than

urine

No sample substitution possible

CON

Limited number of labs able to

process results

People with skin eruptions,

excessive hair, or cuts and

abrasions cannot wear the patch

Passive exposure to drugs may

contaminate patch and affect

results

WINDOW OF DETECTION

Patch retains evidence of

drug use for at least 7

days, and can detect even

low levels of drugs 2 to 5

hours after last use

PRIMARY USES

Used primarily for follow-up testing and return-to-duty testing. Patch is applied to upper arm and back.

SAMHSA…. “on the basis of available information, the department considers the statement that under normal circumstances, the external absorption of any drugs via the external shell into the patch is impossible”.

NIDA 5 Panel – Federal testing

Marijuana (THC)

Cocaine

Amphetamines

Amphetamine

Methamphetamine

MDMA

MDA

MDEA

Opiates

Codeine

Morphine

6-AM (heroin)

Phencyclidine (PCP

Labcorp 12 panel

Adulteration (dilution)

testing−creatinine;

amphetamines;

barbiturates;

benzodiazepines;

cannabinoids (THC);

cocaine (as benzoylecgonine);

ethanol (alcohol);

meperidine (Demerol®);

methadone (Dolophine®);

opiates (codeine, morphine,

hydrocodone, hydromorphone);

oxycodone (oxycodone,

oxymorphone);

phencyclidine (PCP);

propoxyphene (Darvon®);

tramadol

Drugs of Abuse – synthetics and others

Medtox test 2950 : Psychoactive Drugs of Abuse,urine,qualitative/quantitative

2C-B;

2C-E;

2C-H;

2C-I;

4-methylethcathinone;

5-MeO-DALT;

6-APB;

alpha-methyltryptamine;

alpha-PVP;

A-PVP;

a-PVP;

Bromo-dragonfly;

BZP;

Cathinone;

DMT;

Ethlone/Butylone;

Ethylethcathinone;

Fluoro-methamphetamine;

JWH-018 N-pentanoic acid;

JWH-073 N-butanoic acid;

Kratom;

LSD;

m-CPP;

MDAI;

MDPBP;

MDPPP;

MDPV;

MeO DIPT;

Mephedrone;

Methcathinone;

Methedrone;

Methoxetamine;

Methylone;

Mitragine;

Naphyrone;

Pentedrone

Pentylone;

TFMPP;

UR-144 N-4-hydroxy-pentyl;

XLR-11 N-4-hydroxy-pentyl

Designer Drugs ???

Lysergamides[edit] Lysergamides are amide derivatives of the alkaloid lysergic acid. 1P-ETH-LAD, 1-Propionyl-ETH-LAD 1P-LSD, 1-Propionyl-LSD ALD-52, 1-Acetyl-LSD AL-LAD, 6-Allyl-6-Nor-LSD ETH-LAD, 6-Ethyl-6-Nor-LSD LSM-775, N-Morpholinyllysergamide LSZ, LA-SS-Az 4-AcO-DALT, Dalcetin 4-AcO-DET, Ethacetin 4-AcO-DiPT, Ipracetin 4-AcO-DMT, Psilacetin 4-AcO-DPT, Depracetin[6]

4-AcO-EiPT, Ethipracetin 4-AcO-MET, Metacetin 4-AcO-MiPT, Mipracetin 4-HO-DALT, Dalocin[7]

4-HO-DET, Ethocin 4-HO-DiPT, Iprocin 4-HO-DPT, Deprocin 4-HO-MET, Metocin 4-HO-MiPT, Miprocin 4-HO-MPMI, Lucigenol 4-HO-MPT, Meprocin 5-Bromo-DMT 5-MeO-DALT 5-MeO-DET 5-MeO-DiPT, Foxy 5-MeO-DMT 5-MeO-DPT 5-MeO-EiPT 5-MeO-EPT[8]

5-MeO-MALT 5-MeO-MET[9]

5-MeO-MiPT, Moxy 5-MeO-MPMI 5-MeO-NiPT[10]

5-MeO-TMT, Indapex DALT, Diallyltryptamine DET, Diethyltryptamine DiPT, Diisopropyltryptamine DPT, Dipropyltryptamine 4-PO-DET, Ethocybin, CEY-19 EiPT, Ethylisopropyltryptamine EPT, Ethylpropyltryptamine MiPT, Methylisopropyltryptamine McPT, Methylcyclopropyltryptamine[11]

EcPT PcPT MET, Methylethyltryptamine Benzofurans[edit] 5-MeO-DiBF Dimemebfe, 5-MeO-Benzofuranethanamine, 5-MeO-BFE

3C-E 3C-P Allylescaline, "AL" Escaline, "E" Isoproscaline, "IP" Methallylescaline, "MAL" Proscaline, "P" 2C-x[edit] 2C-x . 2C-B-AN, Brolphetaminil[12]

2C-B-FLY 2C-C 2C-D, 2C-M 2C-E, "Europa" 2C-G 2C-iP, "Jelena" 2C-I 2C-P 2C-T-2 2C-T-4 2C-T-7 2C-T-21 βk-2C-B BOB, β-Methoxy-2C-B BOD, β-Methoxy-2C-D BOHB, β-Hydroxy-2C-B, "βH-2CB" HOT-7 NBxx[edit] 2CBCB-NBOMe 25B-NBF[13]

25B-NBOH 25B-NBOMe, "Nova", Cimbi-36 25C-NBF[14]

25C-NBOH 25C-NBOMe, "Pandora", Cimbi-82 25D-NBOMe, "Divination" 25E-NBOMe 25I-NBF, Cimbi-21 25I-NBMD, Cimbi-29 25I-NBOH, Cimbi-27 25I-NBOMe, "Solaris", Cimbi-5 25iP-NBOMe[15]

25H-NBOMe[16]

25N-NBOMe 25P-NBOMe C30-NBOMe[17]

Mescaline-NBOMe[18]

DOx[edit]

Aleph

Bromo-DragonFLY, DOB-DragonFLY

DOB

DOC

DOE, DOET, "Hecate"

DOI

DOiPR, DOiP

DOM, "STP"

DON

DOPR

TMA-2

TMA-6

ZDCM-042-Fluorodeschloroketamine, 2-FDCK, Fluoroketamine, 2-Fluoroketamine

2'-Oxo-PCE, Eticyclidinone, O-PCE, Deschloroethylnorketamine, 2-DCNEK[19]

2-Trifluoromethyldeschloroketamine , 2-TFMDCK

3-HO-PCE, Hydroxyeticyclidine[20]

3-HO-PCP, Hydroxyphencyclidine

3-MeO-PCE, Methoxyeticyclidine

3-MeO-PCMo

3-MeO-PCP

4-MeO-PCP, Methoxydine

Deschloroketamine, 2'-Oxo-PCM, 2-DCK, DCK, O-PCM

Eticyclidine, PCE, CI-400

Methoxetamine, MXE, 3-MeO-2'-Oxo-PCE

Methoxmetamine, MXM, MMXE, 3-MeO-2'-Oxo-PCM, E-MXE

Methoxyketamine, 2-MeO-2-Deschloroketamine, 2-MeO-Ketamine

N-Ethylnorketamine, NENK, N-Ethylketamine

2-Chloro-Ephenidine

2-MeO-Ephenidine

Diphenidine

Ephenidine, NEDPA, EPE

Fluorolintane

Methoxphenidine, 2-MeO-Diphenidine, MXP

N-Methylephenidine, "Ephenidine-2“

2C-B-BZP

3-Chlorophenylpiperazine, meta-Chlorophenylpiperazine, mCPP

4-Fluorophenylpiperazine, para-Fluorophenylpiperazine, pFPP, 4-FPP, Fluoperazine, Flipiperazine

4-Methoxyphenylpiperazine, para-Methoxyphenylpiperazine, MeOPP, pMPP, 4-MPP, Paraperazine

Benzylpiperazine, BZP

Dibenzylpiperazine, DBZP

Difluoromethylenedioxybenzylpiperazine, DF-MDBP, DB-MDBP[21]

Methoxypiperamide, MEOP, MEXP

Methylbenzylpiperazine, MBZP

Methylenedioxybenzylpiperazine, MDBZP, Piperonylpiperazine

Trifluoromethylphenylpiperazine, TFMPP

5-Methoxymethylone, βk-MMDMA, "2-A1MP"

5-Methylethylone, 5-Me-βk-MDEA, 5-ME

5-Methyl-MDA

Butylone, βk-MBDB

Dibutylone, βk-DMBDB

Difluoromethylenedioxyamphetamine, DiFMDA

Dimethylone, βk-MDDMA, "M11"[22]

Dipentylone, βk-DMBDP[23]

EBDB, Ethylbenzodioxolylbutanamine

EDMA, Ethylenedioxymethylamphetamine

EFLEA, N-Hydroxy-EDMA[24][25]

Ethylone, βk-MDEA

Eutylone, βk-EBDB, N-Ethyl-Butylone

FLEA, Methylenedioxyhydroxymethamphetamine, MDHMA

MBDP, Methylbenzodioxylpentanamine

MBDB, Methylbenzodioxylbutanamine, "Eden"

MDEA, Methylenedioxyethylamphetamine, MDE, "Eve"

Methylenedioxyhydroxyamphetamine, MDOH

Methylenedioxydeschlorobupropion, N-Tert-Butyl-Methylone

Methylenedioxyphenylacetamide, MDPA

Methylone, βk-MDMA

MMDA, 5-MeO-MDA

MMDA-2, 6-MeO-MDA

Pentylone, βk-MBDP

Putylone, βk-PDBD, N-Propylbutylone

5-APB

5-EAPB

5-MAPB

5-APDB

5-MAPDB

5-MBPB[26]

6-APB, "Benzo Fury"

6-EAPB

6-MAPB

6-APDB

6-MAPDB4-BA, 4-Bromoamphetamine, PBA

4-CA, 4-Chloroamphetamine, PCA

4-CMA, 4-Chloromethamphetamine, PCMA

4-FA, 4-Fluoroamphetamine, PFA

4-FMA, 4-Fluoromethamphetamine, PFMA

4-MA, 4-Methylamphetamine, PAL-313

4-MeOA, 4-Methoxyamphetamine, PMA, 4-MeO-A, "Death"

4-MeOMA, 4-Methoxymethamphetamine, PMMA, 4-MeO-MA

4-MTA, 4-Methylthioamphetamine

4-NMA, 4-Nitromethamphetamine

Methamnetamine, N-Methyl-PAL-287, Methylnaphetamine, MNT, MNA

MMA, 3-Methoxy-4-Methylamphetamine

Piperidines[edit]

Cyclo-Methiodrone, TCAT

Stimulants[edit]

mphetamines[edit]

2-FA, 2-Fluoroamphetamine

2-FMA, 2-Fluoromethamphetamine

2-MA, 2-Methylamphetamine, Ortetamine

3-FA, 3-Fluoroamphetamine

3-FMA, 3-Fluoromethamphetamine

β-Phenylmethamphetamine

N,alpha-Diethylphenylethylamine, EAPB

.

2-Chloromethcathinone, 2-CMC

2-Fluoromethcathinone, 2-FMC[27]

2-Methylethcathinone, 2-MEC[28]

2-Methylmethcathinone, 2-MMC[29]

2,4-Dimethylethcathinone, 2,4-DMEC[30]

2,4-Dimethylmethcathinone, 2-Methylmephedrone, 2,4-DMMC[31]

3,4-Dimethylmethcathinone, 3,4-DMMC

3,4-Dimethyl-N-ethylbuphedrone, 3,4-DMNEB[16]

3,4-Dimethyl-N-ethylpentedrone, 3,4-DMNPD[16]

3-Chloromethcathinone, 3-CMC, Metaclephedrone, Clophedrone[32]

3-Ethylethcathinone, 3-EEC[33]

3-Fluoromethcathinone, 3-FMC

3-Methoxymethcathinone, 3-MeOMC[34]

3-Methylethcathinone, 3-MEC[35]

3-Methylmethcathinone, 3-MMC

4-Bromomethcathinone, 4-Bromomethcathinone, 4-BMC, Brephedrone

4-Bromoethcathinone, 4-BEC[36]

4-Chlorobutylcathinone, 4-CBC

4-Chlorodimethylcathinone, 4-CDMC

4-Chloroethcathinone, 4-CEC[37]

4-Chloroisopropylcathinone, 4-CiPC

4-Chloromethcathinone, 4-CMC, Clephedrone[38]

4-Ethylethcathinone, 4-EEC

4-Ethylmethcathinone, 4-EMC

4-Fluoroethylmethcathinone, 4-EFMC

4-Fluoromethcathinone, Flephedrone, 4-FMC]

4-Fluoro-Piperidinopentiophenone, 4F-PPP

4-Fluoropentedrone, 4-FPD [40]

4-Methyl-α-Ethylaminopentiophenone, 4-MEAPP, N-Ethyl-4-Methylpentedrone[41]

4-Methylbuphedrone, 4-MeMABP, BZ-6378

4-Methylcathinone, 4-MC, Normephedrone

4-Methyldimethcathinone, 4-MDMC [42]

4-Methylethcathinone, 4-MEC

4-Methylpentedrone, 4-MPD

4-Methylpropylcathinone, 4-MPC

4-Sulfonyldimethcathinone, 4-SMC, 4-SDMC

Pramipexole

Propentofylline

PRL-8-53

Prucalopride

Pyritinol

Rapastinel, GLYX-13

Rasagiline

Roflumilast

Selank

Selegiline

Semax

Sufranal

Sulbutiamine

Sunifiram

Taltirelin

Tianeptine

Unifiram

Vinpocetine

WAY-100,635

Racetams[edit]

Racetams are a class of drugs that share a pyrrolidone nucleus. Many, such as piracetam, but not all, are considered nootropics.

Aloracetam

Aniracetam

Cebaracetam

Coluracetam

Dimiracetam

Doliracetam

Etiracetam

Fasoracetam

Imuracetam

Nebracetam

Nefiracetam

Oxiracetam

Phenylpiracetam hydrazide

Phenylpiracetam

Pramiracetam

Rolziracetam

Benzedrone, 4-MBC Buphedrone, α-Methylamino-Butyrophenone, MABP DL-4662, Dimethoxyethylpentedrone, VEVP[43]

Ephylone, N-Ethylpentylone, βk-Ethyl-K, βk-EBDP Ethcathinone, EC Hexedrone, α-Methylamino-Caprophenone 4-Methylmethcathinone, Mephedrone, 4-MMC, 4-

Methylephedrone, "MCAT" 4-Methoxymethcathinone, Methedrone, βk-PMMA, 4-

Methoxyephedrone, 4-MeoMC Mexedrone N,N-Diethyl-4-Methcathinone, N,N-DEMC N-Ethylbuphedrone, NEB N-Ethylhexedrone, NEH, "Hexen" N-Ethylpentedrone, NEPD 4-Fluoro-N-Ethylbuphedrone, 4-Fluoro-NEB, 4-FNEB NiPP, α-Isopropylamino-Valerophenone, iPAVP, N-

Isopropylpentedrone, NPP[44]

Pentedrone, α-Methylamino-Valerophenone, MAVP, PD α-Ethylaminopentiophenone, EAPP, N-Ethylpentedrone[41]

βk-IBP, Indanyl-N-ethylbuphedrone[16]

βk-IVP, Indanyl-N-ethylpentedrone[16][45]

Diphenylprolinol, D2PM 2-Diphenylmethylpyrrolidine, Desoxy-D2PM α-Pyrrolidinopropiophenone, α-PPP 2',4'-Dimethyl-α-pyrrolidinopropiophenone, DMPPP, 2,4-

DM-α-PPP 3',4'-Methylenedioxy-α-pyrrolidinopropiophenone, MDPPP,

3,4-MD-α-PPP 4'-Chloro-α-pyrrolidinopropiophenone, 4-Chloro-α-PPP 4'-Methoxy-α-pyrrolidinopropiophenone, MOPPP, 4-MeO-

α-PPP 4'-Methyl-α-pyrrolidinopropiophenone, 4-MePPP, MPPP,

MαPPP α-Pyrrolidinobutiophenone, α-PBP 3',4'-Methylenedioxy-α-pyrrolidinobutiophenone, MDPBP,

3,4-MD-α-PBP 4'-Fluoro-α-pyrrolidinobutyrophenone, 4-Fluoro-α-PBP[46]

4-Methoxy-α-pyrrolidinobutyrophenone, 4-MeO-α-PBP[47]

4'-Methyl-α-pyrrolidinobutiophenone, MPBP, 4-Me-α-PBP 5-PPDI, Indanyl-α-PBP[48]

TH-PBP, Cyclohexane-α-PBP α-Pyrrolidinobutiothiophenone, α-PBT[49]

α-Pyrrolidinopentiophenone, α-PVP, βk-Prolintane, O-2387

3',4'-Dimethoxy-α-pyrrolidinopentiophenone, 3,4-DMPV 3',4'-Dimethyl-α-pyrrolidinopentiophenone, 3,4-DMPV[16]

4'-Bromo-α-pyrrolidinopentiophenone, 4-Bromo-α-PVP 4'-Chloro-α-pyrrolidinopentiophenone, 4-Chloro-α-PVP 4'-Fluoro-α-pyrrolidinopentiophenone, 4-Fluoro-PVP, 4-

Fluoro-α-PVP 4'-Methoxy-α-pyrrolidinopentiophenone, 4-MeO-α-PVP, 4-

MeO-PVP, MOPVP 5-DBFPV, 5-Dihydrobenzofuranpyrovalerone, 3-Desoxy-

MDPV Pyrovalerone, 4-Me-α-PVP, Centroton, Thymergix, O-

2371 Methylenedioxypyrovalerone, MDPV Naphyrone, Naphthylpyrovalerone, O-2482 Pyrophenidone, α-Phenyl-Pyrovalerone Indapyrophenidone, Indanyl-α-Phenyl-α-PVP TH-PVP, Cyclohexane-α-PVP[50]

α-Pyrrolidinopentiothiophenone, α-PVT α-Pyrrolidinoisohexaphenone, α-PiHP α-Pyrrolidinohexiophenone, α-PHP, PV-7 3',4'-Dimethoxy-α-PHP, 3,4-DMPH[25]

4'-Fluoro-α-pyrrolidinohexiophenone, 4-Fluoro-α-PHP 4'-Methyl-α-pyrrolidinohexiophenone, MPHP, 4-Me-α-PHP,

PV-4 4'-Methoxy-α-pyrrolidinohexiophenone, 4-MeO-α-PHP TH-PHP, Cyclohexane-α-PHP 5-BPDI, Indanyl-α-PHP[51]

Methylenedioxypyrrolidinohexiophenone, MDPHP [16][52]

α-Pyrrolidinoheptiophenone, PV-8, α-PHPP[53]

4'-Fluoro-α-pyrrolidinoheptiophenone, 4-Fluoro-PV-8, 4-Fluoro-α-PHPP[41]

4'-Methoxy-α-pyrrolidinoheptiophenone, 4-MeO-PV-8, 4-MeO-α-PHPP

α-Pyrrolidinooctanophenone, PV-9, α-POP[41]

4'-Fluoro-α-pyrrolidinooctanophenone, 4-Fluoro-PV-9, 4-Fluoro-α-POP

4'-Methoxy-α-pyrrolidinooctanophenone, 4-MeO-PV-9, 4-MeO-α-POP[54]

α-Pyrrolidinononanophenone, PV-10, α-PNP [55]

2-Diphenylmethylpyrrolidine, Desoxy-D2PM, 2-Benzhydrylpyrrolidine

3,4-Dichloromethylphenidate, 3,4-CTMP

4'-Fluorococaine, 4'-FC

4-Benzylpiperidine, 4-PMPD

4-Fluoroethylphenidate, 4F-EPH, 4-FEPH

4-Fluoromethylphenidate, 4-FMPH, 4-FMPH

4-Methylmethylphenidate, 4-Me-TMP, 4-MMPH

Benocyclidine

Desoxypipradrol, 2-DPMP, 2-Diphenylmethylpiperidine

Dichloropane, RTI-111, O-401

Ethylphenidate, EPH

HDEP-28, Ethylnaphthidate

HDMP-28, Methylnaphthidate

Isopropylphenidate, IPH, IPPD

Meprylcaine

Nitracaine, 4-Nitro-Dimethocaine

Pipradrol, Meratran

Propylphenidate, PPH

Troparil, WIN 35,065-2, β-CPTIsophenmetrazine, PAL-730[56]

2-Hydroxy-4'-Ethylphenmetrazine, 2-HO-4'-EPM, 2-Hydroxyphenmetetrazine, N-Ethylphenmetrazol

3,4-Methylenedioxyphendimetrazine, MDMPM

3-Fluorophenetrazine, 3-FPE[57]

3-Fluorophenmetrazine, 3-FPM, PAL-593

3-Methylphenmetrazine, 3-MPM, PAL-773

N-Ethylphenmetrazine, Phenmetetrazine[58]

4-Methylphenmetrazine, 4-MPM

6-Methylphenmetrazine, 6-MPM

G-130

Methylmorphenate

PDM-35, 5-Methylphenmetrazine, 5-MPM

Phenetrazine, PE[59]

Viloxazine

Phenylacetamides[edit]

2-PA, 2-Phenylacetamide

2-PTA, 2-(4-methylphenyl)acetamide

Misc[edit]

1,3-Dimethylbutylamine, 1,3-DMBA, "AMP-Citrate"

2-AI

2-MPPP, 2-methyl-1-phenyl-3-(piperidin-1-yl)propan-1-one

4-Fluorodimethocaine

Amfonelic acid, AFA, WIN 25,978

Bromantane

Camfetamine

CRL-40,940, Bisfluoromodafinil

CRL-40,941, Fladrafinil, Fluorafinil

Diclofensine, Ro 8-4650

Dimethocaine, Larocaine

Homomazindol

Mephtetramine, MTTA[60]

Methylhexanamine, DMAA

Modafiendz, Methyldifluoromodafinil[61]

Sedatives[edit]

.

Opioids[edit]

Opioids have pharmacologic actions resembling morphine and other components of opium.

3-Methylbutyrfentanyl, 3-MBF

3-Methylfentanyl, 3-MF

4-Chloroisobutyrfentanyl, 4-CliBF, p-CliBF

4-Fluorobutyrfentanyl, 4-FBF, p-FBF

4-Fluoroisobutyrfentanyl, 4-FiBF, p-FiBF

4-Methoxybutyrfentanyl, 4-MeO-BF, p-MeO-BF

4-Fluorofentanyl, 4-FF, p-FF

Acetylfentanyl, AF

Acrylfentanyl

AD-1211AH-7921

α-Methylfentanyl, "China White"

Butyrfentanyl, BF

Desmethylprodine, MPPP

Furanylfentanyl, Fu-F

4'-Nitromethopholine

MT-45

Nortilidine

O-Desmethyltramadol

U-51754[62]

U-47700

U-77891

Valerylfentanyl, VF

W-15[63]

W-18

Benzodiazepines[edit]

3-Hydroxyphenazepam

Adinazolam

Clonazolam, 8-Nitrodeschlorotriazolam, Clonitrazolam

Cloniprazepam, 1-Cyclopropylmethylclonazepam[64]

Desmethylflunitrazepam, Fonazepam

Diclazepam, 2'-Chlorodiazepam

Flubromazepam

Flubromazolam

Flunitrazolam, 2'-Fluorodeschloroclonazolam

Meclonazepam, 3-Methylclonazepam

N-Desalkylflurazepam, Norflurazepam

Nitemazepam, 3-Hydroxynimetazepam

Nifoxipam, 3-Hydroxydesmethylflunitrazepam

Nitrazolam

Phenazepam

Pyrazolam

Ro5-4864 4'-Chlorodiazepam

Thienodiazepines[edit]

Deschloroetizolam, "Etizolam-2"[65]

Etizolam

Desmethyletizolam, Metizolam

1,4-Butanediol, 1,4-BD

GBL, γ-Butyrolactone

GHV, γ-Hydroxyvaleric acid (4-Methyl-GHB)

GVL, γ-Valerolactone

Afloqualone

Etaqualone, 2-Ethylnormethaqualone, "ECQ"

Mebroqualone, 2-Bromonormethaqalone, "MBQ"

Mecloqualone, 2-Chloronormethaqualone, "MCQ"

Methylmethaqualone, 4-Methylmethaqualone, "MMQ"

Nitromethaqualone, 2-Methoxy-4-nitronormethaqualone

2-Methyl-2-butanol, 2M2B, tert-Amyl alcohol

2-Methyl-2-pentanol

3,4,5-Trimethoxyphenibut

4-Fluorophenibut

Benzylbutylbarbiturate

Pagoclone

Phenibut

CP 47,497 and its (C8) homologue cannabicyclohexanol

CP 55,940

HU-308

HU-210

5F-AB-FUPPYCA, AZ-037

5F-PCN, 5F-MN-21

A-836,339

AB-CHFUPYCA

BAY 38-7271

BIM-018

CB-13

EG-018[66]

EG-2201[67]

FUBIMINA, BIM-2201, BZ-2201, FTHJ

JTE-907

JTE 7-31

LY-2183240

MDA-19

MDMB-CHMCZCA, EGMB-CHMINACA[68]

NESS-0327

NESS-040C5

NNL-1[69]

QMPSB

WIN 55,212-2

JWH-098

JWH-116

JWH-122

JWH-149

JWH-182

JWH-193

JWH-198

JWH-200

JWH-210

JWH-398

JWH-424

MAM-2201

NM-2201, CBL-2201

JWH-167

JWH-203

JWH-249

JWH-250

JWH-251

JWH-320[84]

RCS-8

Acetildenafil

Aildenafil

Aminotadalafil[92]

Gendenafil

Homosildenafil

Hydroxyacetildenafil

Hydroxyhomosildenafil

Hydroxythiohomosildenafil

Nitrosoprodenafil

Piperidinoacetildenafil

Piperidinovardenafil

Sulfoaildenafil

Thiosildenafil

Nootropics[edit]

Nootropics are drugs that improve one or more aspects of mental function, such as working memory, motivation, and attention.

Alagebrium

(-)-BPAP

Dihexa

Dimethylethanolamine, DMAE

Edaravone

Emoxypine

Epitalon

9-Fluorenol, Hydrafinil

9-Fluorenone, Oxafinil

Idebenone

IDRA-21

Isoxazole-9, ISX-9[93]

J147

JDTic

Meclofenoxate, Centrophenoxine

Memantine

N-Acetyl-Epitalon

N-Acetyl-Selank

N-Acetyl-Semax

N-Acetyl-Semax-Amidate

Nilotinib

Noopept

NRX-1074

NSI-189

Picamilon

Pitolisant

(-)-PPAP

5C-APINACA, 5C-AKB48[70]

5F-AB-PINACA

5F-ADB-PINACA

5F-ADB, 5F-MDMB-PINACA

5F-AMB

5F-APINACA, 5F-AKB48

5F-CUMYL-PINACA, SGT-25, C-Liquid

5F-EMB-PINACA, 5F-AEB

5F-MN-18[71]

5F-NPB-22[72]

5F-SDB-005[73]

AB-CHMINACA

AB-FUBINACA

AB-PINACA

ADAMANTYL-THPINACA

ADB-BINACA[74]

ADB-CHMINACA, MAB-CHMINACA, "MA-CHMINACA"

ADB-FUBINACA, MAB-FUBINACA

ADB-PINACA, MAB-PINACA

ADSB-FUB-187

AMB[75]

AMB-CHMINACA, "MA-CHMINACA"

AMB-FUBINACA, FUB-AMB, MMB-FUBINACA

APINACA, AKB48

APP-FUBINACA

BiPICANA[76]

CUMYL-PINACA, SGT-24

CUMYL-THPINACA, SGT-42

EMB-FUBINACA, FU-AEB[77]

FAB-144

FUB-APINACA, FUB-AKB48

FUB-NPB-22[78]

IPO-33

MDMB-CHMINACA, MDMB(N)-CHM

MDMB-FUBINACA, MDMB(N)-Bz-F, MDMB-Bz-F, FUB-MDMB

MN-18

NPB-22[79]

PX-2, 5F-APP-PINACA, FU-PX, PPA(N)-2201

PX-3, APP-CHMINACA

SDB-005

THJ-018

THJ-2201

4-HTMPIPO

5C-MN-24, 5C-NNEI[41]

5F-AB-PICA[80]

5F-ADBICA

5F-AMB-PICA, I-AMB, MMB-2201

5F-AMP

5F-NNE1, 5F-NNEI, 5F-MN-24

5F-PY-PICA[81]

5F-SDB-006

AB-005

AB-BICA[74]

AB-FUBICA

AB-PICA

ADB-BICA[69]

ADB-FUBICA

ADBICA, ADB-PICA

APICA, SDB-001, 2NE1

AMB-CHMICA, MMB-CHMICA, "MA-CHMINACA"[82]

BzODZ-EPyr

CUMYL-PICA

FDU-NNE1, FDU-NNEI, FDU-MN-24

FUB-144, FUB-UR-144

LTI-701

MDMB-CHMICA, incorrectly known as MMB-CHMINACA

MDMB-FUBICA

MEPIRAPIM

MN-25

NNE1, NNEI, MN-24

NNL-2[69]

Org 28611, SCH-900,111

PTI-1

PTI-2

PX-1, 5F-APP-PICA, SRF-30

SDB-006

STS-135, 5F-APICA

UR-144

XLR-11, 5F-UR-144

5F-PB-22

BB-22, QUCHIC

FDU-PB-22

FUB-PB-22

PB-22, QUPICAM-630

AM-679

AM-694

AM-1241

AM-2233

RCS-4

AB-001

AB-002

AM-1248

AM-1220

AM-1221

AM-1235

AM-2201

AM-2232

CBL-018, NM-018[83]

EAM-2201

FUB-JWH-018

JWH-007

JWH-015

JWH-018

JWH-019

JWH-073

JWH-081

Acetildenafil

Aildenafil

Aminotadalafil[92]

Gendenafil

Homosildenafil

Hydroxyacetildenafil

Hydroxyhomosildenafil

Hydroxythiohomosildenafil

Nitrosoprodenafil

Piperidinoacetildenafil

Piperidinovardenafil

Sulfoaildenafil

Thiosildenafil

Alagebrium

(-)-BPAP

Dihexa

Dimethylethanolamine, DMAE

Edaravone

Emoxypine

Epitalon

9-Fluorenol, Hydrafinil

9-Fluorenone, Oxafinil

Idebenone

IDRA-21

Isoxazole-9, ISX-9[93]

J147

JDTic

Meclofenoxate, Centrophenoxine

Memantine

N-Acetyl-Epitalon

N-Acetyl-Selank

N-Acetyl-Semax

N-Acetyl-Semax-Amidate

Nilotinib

Noopept

NRX-1074

NSI-189

Picamilon

Pitolisant

(-)-PPAP

Pramipexole

Propentofylline

PRL-8-53

Prucalopride

Pyritinol

Rapastinel, GLYX-13

Rasagiline

Roflumilast

Selank

Selegiline

Semax

Sufranal

Sulbutiamine

Sunifiram

Taltirelin

Tianeptine

Unifiram

Vinpocetine

WAY-100,635

Aloracetam

Aniracetam

Cebaracetam

Coluracetam

Dimiracetam

Doliracetam

Etiracetam

Fasoracetam

Imuracetam

Nebracetam

Nefiracetam

Oxiracetam

Phenylpiracetam hydrazide

Phenylpiracetam

Pramiracetam

Rolziracetam

C.E.P., Local 30 v. Irving Pulp & Paper,

Ltd., 2013 SCC 34

In 2006, Irving unilaterally adopted

a drug-testing policy in which 10%

of employees in “safety sensitive”

positions would be tested for drug

and alcohol use each year.

Day, a teetotaler since 1979, was

tested for alcohol, and his

breathalyzer test indicated a blood

alcohol level of zero.

Subsequent to this test, the union

filed a grievance on Day’s behalf.

Judicial Review – When is drug testing

reasonable

Inherently allowed

Where there are reasonable grounds to believe an employee was impaired while on duty.

Where an employee was directly involved in a workplace accident or significant incident.

Where the employee returns to work after treatment for substance abuse.

Variable

Random testing is allowed if the

employer can demonstrate that the

worksite has a problem with

substance abuse, it is not

inherently assumed

If the testing has been part of a

negotiation labor management

agreement